title: Adult onset Still's disease: review of 41 cases.
abstract: OBJECTIVE
  To describe the clinical, laboratory and radiological features, treatment and prognosis of patients with adult onset Still's disease (AOSD).
  
  
  METHODS
  Specific clinical features were retrospectively recorded in 41 patients fulfilling the Yamaguchi criteria. Patients were reviewed in two academic hospitals with a referral area of 700,000-1,000,000 inhabitants. Laboratory tests including haemogram, ferritin, biochemistry and autoimmunity were reviewed. Radiological studies, treatment and ACR functional class were determined.
  
  
  RESULTS
  Forty-one patients with AOSD were identified, 25 of whom were female. Mean age at diagnosis: 38.19 years (range 17-68). Feverish polyarthritis was the most common clinical presentation. Acute phase reactants were invariably high in all patients. Serum ferritin levels were elevated in 86% of patients. Anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) were negative in all patients except one. The course of the disease was monocyclic in 44% of the patients, polycyclic in 26%, and chronic articular in 30%. ACR class was as follows: 29 (72.5%) class I, 7 (17.5%) class II, 2 (5%) class III and 2 (5%) class IV. As for the treatment received, aspirin or NSAIDs controlled the disease in eight patients (19.5%) and high-dose corticosteroids (0.5-1 mg/kg/day) in 32 (78%). Almost half of the patients (49%) required an additional diseasemodifying agent, usually methotrexate. Finally, in seven of them (17%) a biological treatment with TNF-α or specially anti-IL-1 had to be added to control the disease.
  
  
  CONCLUSIONS
  The clinical and laboratory findings were similar to previous studies. Anti-CCP antibodies were almost always negative. A monocyclic course was associated with a good prognosis. Most of the patients were in ACR functional class I and II. Biological agents were required in 7 patients (17%).
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. riera.elena@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Riera
authors.forename: Al
authors.initials: A
authors.lastname: Olivé
authors.forename: J
authors.initials: J
authors.lastname: Narváez
authors.forename: S
authors.initials: S
authors.lastname: Holgado
authors.forename: P
authors.initials: P
authors.lastname: Santo
authors.forename: L
authors.initials: L
authors.lastname: Mateo
authors.forename: M M
authors.initials: MM
authors.lastname: Bianchi
authors.forename: J M
authors.initials: JM
authors.lastname: Nolla
mesh_terms: D000328:Adult; D006801:Humans; D011379:Prognosis; D011859:Radiography; D016706:Still's Disease, Adult-Onset / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome